"Prolotherapy works when done properly by a professional specialist and particularly when using an ultra-sound device, like Dr. Hal Brown is doing."

"I have to admit that using this guided ultra sound for my prolotherapy injections, was different this time. I felt that the injection administered to my groin and lower back to go right into the roots of the joints and ligaments where I feel most pain and discomfort."

If we can see the needle, we are less likely to place it somewhere undesirable and very likely to place it exactly where we want it.

The use of ultrasound guidance in prolotherapy, PRP and stromal vascular fractions (MSC) injections has been experiencing increased use in the past few years as the technology has improved and become available for clinical use. When I originally trained in prolotherapy injections, palpation and anatomy knowledge were the landmarks that were used to target the injection sites. Certainly many doctors were highly skilled and excellent clinical results occurred using what are called “blind” techniques. Even when ultrasound first became available, I initially believed as many still do, that the excellent results did not require better guidance.

Since first studying ultrasound guidance methods in 2011, I have come to a different opinion. Although ultrasound guidance will make identification and injection of targeted sites more specific, the debate about its use is whether there are better outcomes with it. There is no substitute for good clinical diagnostic skills, assessment, proper treatment choices, patient selection and anatomical and pathological knowledge. Examination, palpation, anatomy, physiology and injection experience are critical factors in outcome success. Ultrasound use is not a substitute for poor clinical skills, and in fact, a good “blind” prolotherapy treatment is still better than an ultrasound guided injection without the clinical skill. However, when we combine good clinical skills with good ultrasound skills, it is my opinion that we can get a better outcome with less risk. If we can see the needle, we are less likely to place it somewhere undesirable and very likely to place it exactly where we want it.

The other advantage of using ultrasound, is the ability to identify pathology and more accurately identify the causes of pain. For example spurs, calcifications and tears cannot be palpated and visualization on ultrasound provides very specific treatment options such as injection into tears, aspiration or breakup of calcifications and tenotomy of spurs with the needle. Boney erosion sites are also identifiable. Often pain may be caused by nerve entrapments which can be identified, targeted and successfully treated with needle hydro dissection. Images of pathology can be taken and saved and compared to future images to determine progress.

Studies Comparing Ultrasound with Blind Injection

There have been many studies that have compared ultrasound guided injections to “blind” injections. It can be demonstrated that ultrasound guided injection, improves treatment outcomes. The research does indicate that there is a significantly higher rate of accuracy, which by inference would suggest better outcomes.